P1598: SARS-COV2 INFECTION IN FULLY VACCINATED PATIENTS WITH LYMPHOID MALIGNANCIES DURING THE “THIRD WAVE”: A SINGLE-CENTER EXPERIENCE OF 57 PATIENTS.
Authors: V. Strafella, T. Perrone, P. Masciopinto, A. Giordano, F. Gaudio, M. C. Longo, O. Battisti, E. Arcuti, L. Strippoli, G. Brindicci, A. Saracino, P. Stefanizzi, S. Tafuri, F. Albano, P. Musto
Journal: HemaSphere (2022)

Background: COVID-19-related mortality rates are increased in hematological patients and those with lymphoid malignancies look particularly vulnerable to SARS-CoV-2 infection, due to the characteristics of their disease and the anti-neoplastic treatments used. Vaccines against SARS-CoV-2 have been rapidly developed. However, patients treated with anti-CD20 monoclonal antibodies have shown lower seroconversion rates after receiving mRNA SARS-CoV-2 vaccines. Several antiviral agents, such as molnupiravir and remdesivir, and some monoclonal antibodies have been also used for the management of COVID-19 in order to reduce the risk of progression to severe disease. Aims: The aim of this study was to evaluate the outcome of SARS-Cov2 infection in a population of patients affected by chronic lymphocytic leukemia (CLL), Hodgkin lymphoma (HL), B- and T-cell non-Hodgkin lymphomas (NHLs) during the so-called “third wave” of SARS-CoV-2 pandemic. Methods: We performed a retrospective analysis of 57 patients affected by CLL (n. 12), HL (n. 8), B (n. 34) and T-cell (n. 3) NHLs who experienced SARS-CoV2 infection between December, 1, 2021, and February, 26, 2022. All patients had received a complete cycle of anti-SARS-Cov2 vaccine before infection. They were diagnosed by RT-PCR or by antigen rapid test on nasopharyngeal swabs. We collected data about sex, age, histological features, anti-neoplastic regimens, symptoms, hospitalization, mortality, use of antiviral drugs or monoclonal antibodies for the treatment of COVID-19, time to SARS-CoV-2 negativity. Results: The median age of the whole group was 58 (18-94) years. Thirty-two patients (56%) were male, while 26 (44%) were female. As far as histological features are concerned, follicular lymphoma was the most frequent one (35%). Within the last 12 months before SARS-CoV-2 infection, 40 patients (70%) had received treatment for their hematological disease, 17 (30%) were on anti-CD20 maintenance, 12 (21%) on treatment with immuno-chemotherapy (ICT), 6 (11%) on ibrutinib, 3 (5%) on checkpoint inhibitors and 3 (5%) were on chemotherapy only. All patients had received two doses of anti-SARS-CoV-2 vaccines, and 77% of them a further, booster dose. The most common symptoms at presentation were fever, cough, muscle pain, headache, fatigue. Overall, 15 (26%) patients were hospitalized, and, among them, 4 (7%) were admitted to intensive care units (ICUs). Fifteen (26%) patients received an antiviral drug, while 4 (7%) hospitalized patients received monoclonal antibodies for the treatment COVID-19. Average time length to reach a negative test for SARS-CoV-2 was 17 days. Sixteen (28%) patients remained positive after 5-to-61 days and 6 (11%) patients died. At univariate analysis, CLL and Diffuse Large B-Cell Lymphoma (DLBCL) (p 0.026), as well as treatment with ICT or BTK inhibitors (p 0.002), were significantly associated to a worse overall survival (OS). Notably, maintenance therapy with anti-CD20 monoclonal antibodies as single agents had no impact on OS. Moreover, the cumulative incidence of nasopharyngeal swabs turned negative was significantly lower in patients treated with ICT (p 0.001). Booster dose and antiviral treatments did non influence neither OS, nor time to a negative viral test. Summary/Conclusion: In our study histological subtype and type of treatment, but not antiviral therapies, had prognostic impact on the outcome of SARS COV 2 infection in patients with lymphoproliferative disorders during the current phase of pandemic. These findings warrant to be further investigated in larger series.